Category Archives: Respiratory

A common complaint I hear from parents is their child has noisy breathing. One frequent concern is that it may be wheezing, or asthma. Here is a short guide to noisy breathing.

Infants often have noisy breathing. It’s usually heard on the inhale. Most often it is not associated with any coughing or problems with feeding or sleep. In fact it usually bothers the parents much more than it bothers the child. Babies often have some nasal congestion. They have very small nasal passages and any irritation or even temperature variation can cause some swelling in the mucosa, or lining of the nose, that makes them sound “congested”. Another common issue with small babies is called laryngomalacia. That is a fancy term for a soft or slightly weak larynx. When the baby breathes in, it collapses a bit causing a raspy noise. This usually improves markedly when the child is laid on its stomach (for tummy time, not for sleep, of course) and gets worse when the child is on its back. However, it is not dangerous and doesn’t cause the baby any distress. If baby looks like his breathing is labored that could be a more serious problem. One would see the head bobbing up and down and the stomach going sharply in and out when breathing. Also if cough is present it should be brought to a medical provider’s attention. Furthermore if the baby is having difficulty with feeds, she should see a doctor right away. A more rare problem is called choanal atresia which is a blockage or partial blockage of the nasal passages. These babies would have to pause in their feeding just to breathe through their mouths.

Older children usually get some sort of noisy breathing when they are ill. This may come in various forms. Nasal congestion is the most common and can cause a rattly sound that seems like it must be coming from the chest but often is not. Usually children with nasal congestion alone do have cough due to post nasal drip (the mucous going down the throat at night is irritating), but they don’t have labored breathing, they can usually drink fluids without difficulty, and sleep pretty well. If you are not sure what is happening, it is always best to call the advice nurse or the doctor’s office for help.

Stridor is another sound that babies and young children may make when sick. Again, it is heard when the child inhales. It is usually louder when the child is crying and often disappears when the baby stops crying. Try sucking in your breath as if you were surprised but keep your mouth closed. That’s what stridor sounds like. These babies often have a barky low pitched cough that sounds like a seal. This is most commonly due to a viral illness called croup but also can be heard if the baby has swallowed or inhaled an object and it’s stuck in the laryngeal area. Another illness that can cause stridor that has become quite uncommon in the vaccine age is Epiglottitis. These children are extremely ill with high fever, and need to be seen immediately. Signs that a child should be seen right away are any distress, drooling, high fever, or stridor at rest. If you can hear the funky sound in the breathing when the baby is not crying, call the doctor. Sometimes the advice nurse will be able to listen over the phone and tell you if it’s stridor or not. If someone has croup, standing in front of the open freezer is helpful.

And finally, wheezing. Many people come in saying they think their child is wheezing. Wheezing is often quite difficult to hear without a stethoscope. If it is “audible wheeze”, you generally hear it on the exhale (although it is possible to have it on the inhale). It’s a high pitched musical type of sound. Wheezing can result from different causes. Infants can get wheezing with a bad viral cold, and that is called bronchiolitis. Any child can also get wheezing from asthma, which can start at any age. If there is a strong family history of asthma and/or the baby already has eczema, there is an increased chance of developing asthma. Other causes of wheezing include a foreign object aspirated into the lungs, anatomic abnormalities, other rare infections like TB, and a condition called vocal cord dysfunction (usually seen in older girls). Again the bottom line is to look for signs of distress, such as any dusky or bluish color change, retractions (which means pulling between the ribs, under the clavicles, in the belly, or in the soft area at the base of the neck), coughing so badly that the child can’t sleep or eat properly, for example. Fast breathing can also be a sign of distress but a child can breathe fast with a fever as well so check that the temperature is normal before assuming the fast breathing is due to a respiratory problem.

Parents of children with asthma frequently express frustration when I see them, that they didn’t start the asthma treatments because they didn’t hear any wheezing. Again, wheezing is hard to hear and can be a late sign of an asthma exacerbation so look at cough as the main sign and use the medicine when the cough starts.

If your child is having any of the signs of distress discussed above, or if you think your child has inhaled an object/piece of food, it is important to seek medical attention or advice immediately.